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Shyness: How Normal Behavior Became a Sickness
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3 of 3 people found the following review helpful
on February 9, 2015
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I thought this was a strong book -- well documented and worth reading. I learned a lot about the material that went into DSM-III and all the discussions that have taken place about it since. The author had access to the American Psychiatric Association's archive of papers and the level of detail and documentation clearly shows. Excellent book for nurses, mental health practitioners and the public in general.
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3 of 3 people found the following review helpful
on January 17, 2015
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I found Shyness to be a clear, balanced, and readable history of the DSM, explaining how, despite its many problems, the manual came to be thought an authority in psychiatric diagnoses around the world. The author draws heavily on an archive of unpublished papers at the APA, normally very difficult to access and read, and from revealing interviews with the psychiatrists responsible for many of the new disorders. The debates and controversy around DSM-5 make greater sense in light of the history of earlier editions of the manual, shown well here.
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1 of 1 people found the following review helpful
on August 21, 2014
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Book was in great condition.
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2 of 5 people found the following review helpful
on June 10, 2013
Format: Paperback
The advertisements for Christopher Lane's Shyness often contain the first and final lines of my review of the book in "Metapsychology Online Reviews"(2008)lines that recommended the book for some of its interesting discussions. However the book's main point, a critique of the DSM, is a failure. With the controversies around the new DSM, perhaps a look at my problems with Lane's critique of the DSM would be interesting to some. Here is the complete review. John Mullen.

There is a great deal that's interesting in this book. Chapter one contains an informative history of, "The Hundred Year's War over Anxiety". Chapters two and three provide a great account of the inside wars that gave rise to the revised Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-IIIR and DSM-IV). Chapter four is a clear and somewhat shocking history of how the drug company SmithKlineBeecham remarketed the inferior depression drug Paxil as treatment for social phobia. On the other hand Chapter five, "The Rebound Syndrome", is a rather loose and unconvincing survey of the perils of withdrawal from the new anti-depressives. And Chapter six attempts to support the idea of a backlash against these medications with overly-long summaries of some recent and good fiction.

I am going to take Lane at his word, supported by the book's title, that his main concern is that the new DSM metamorphosed normal behaviors into sicknesses, that shyness is a good example of this phenomenon and that this is a bad thing.

The tale begins with the DSM. It is a familiar story that in the mid 1970s the American Psychiatric Association selected psychiatrist Robert Spitzer to lead a panel that would re-write the diagnostic manual that classifies mental disorders, then called the DSM II (1968). By 1994, the new DSM IV had increased the number of disorder categories from 182 to over 350. Lane quotes a statistic that this definitional reorganization resulted in a thousand fold increase in cases of depression alone (43). On this point I would have liked to have read how Lane would consider this different from similar results when the thresholds for hypertension or excessive cholesterol have been adjusted. In any case Lane has unearthed a great deal about the internal battles and personality conflicts involved in this process, and it's an interesting story that's worthy of expansion into a small book unto itself.

What is Lane's case against the new DSM? Spitzer's claim is that the old DSM was theory laden with psychoanalytic terms and assumptions to the point that it was difficult to diagnose a disorder without committing oneself to some variant of Freudianism. The classic example is the diagnosis of anxiety neurosis that included the technical concept of repression. The idea of the DSM II, IIIR and IV was to classify problems by means of symptoms rather than causes, thus rendering them theory neutral. What's Lane's problem with this ideal?

First, he considers the exclusion of the term "neurosis" from the manual to be a form of anti-Freudian prejudice. Lane quotes Spitzer objecting that the term has "psychoanalytic meaning" (51), with the implication that he had unearthed evidence of prejudice. From Spitzer's standpoint calling persistent anxious behaviors evidence of "neurosis" is the equivalent of calling them evidence of "Zoloft deprivation". The diagnosis itself directs the treatment. Lane makes a good case with interesting historical research that Spitzer and cohorts did not look kindly upon psychodynamic therapies, and that this negative view was a prejudice rather than a scientific conclusion. But he does not make his case that these imperfect motives negatively affected the results of Spitzer's stated program for a theory-neutral DSM.

Lane's second criticism is that the new DSM contains disorders that are not worthy of psychiatric intervention. This is where Lane ties shyness into his central critique of the Spitzer program. His discussion of the messy process of sorting out "anxiety neurosis", "social phobia", "agoraphobia", "panic disorder", "introverted personality", "avoidant personality disorder", "schizoid personality", "social anxiety disorder" and "shyness" is fascinating. But it's not as scandalous as Lane implies. Classification wars have consequences and are not unique to the psychological sciences. Recall, for example, the recent controversies surrounding the redefinition of the astronomical term "planet" that resulted in the exclusion of the much-beloved-by-school-children "planet", Pluto. In any case, the existence of a sloppy process of creation is not an argument against what was created.

Lane's discussion of the psychiatric worthiness of some of Spitzer's new categories, social phobia (shyness) being the exemplar, skims some issues that a philosopher at least would spend some time on. For example, there was a temptation to identify painful shyness with "introverted personality", a concept that was central to Hans Eysenk's personality classification scheme. The objections were many. First Eysenk's use was purely descriptive, implying nothing negative or in any way debilitating. Second, the risk of using "introverted" as a disorder classification threatened to cast what is merely a "way of being" (quiet as opposed to loud, for example) as a mental illness. Third, if "introversion" was defined as an extreme of shyness, it would imply a superiority of extroverted people over their quieter counterparts since extroversion has no natural extreme. (Spitzer's reply that manic disorder was an extreme of extroversion seems to allow for an extroverted introvert since surely one could envision a manic introvert. If Spitzer himself were shy he might have proffered that the extreme of extroversion is "character depth deprivation". One could envision a Newsweek cover story documenting a disturbing increase in CDD in the U. S..)

How exactly should a cognitive, emotional or personality trait, introversion or extroversion, for example, become a treatable trait, that is, a situation worthy of professional attention? Lane laments that Spitzer's group did not respect the criteria of "the 4Ds", significant distress, dysfunction, deviance and danger. These criteria make sense for psychoanalysis, which is conceived as a long, painful, costly and personally transforming experience. Lane quotes the psychoanalyst Otto Will approvingly, "I myself would not treat a person because he was 'introverted'" (83) and Lane shares the horror of psychiatrist Sally Satel and philosopher Christina Hoff Sommers that the DSM IV implies that 26% of Americans, ". . . qualified as having a mental illness within a given year." (201) But what's the source of the scandal? Certainly greater than 26% of Americans qualify as having one or more of the physical diseases listed The Merck Manual 18th Edition, which describes everything from runny noses to brain cancer. Satel and Sommers complain that some of the conditions listed in the DSM IV require no professional intervention but the same is true of The Merck Manual. He approves of Satel and Sommers' claim that, "suffering is sometimes edifying" (205) and notes, "We need more professional skeptics like Satel and Sommers ..." (202) (These are the authors of One Nation under Therapy who all but accused PTSD veterans of being fakers and girlie-men.) The point however is that with new therapies (behavioral, cognitive and drug) that direct their efforts at symptom relief rather than personal transformation, that are quicker, cheaper and effective, the 4Ds are hardly appropriate. Does Lane object that The Merck Manual includes warts, acne and indigestion?

The subtitle of Lane's book is "How Normal Behavior Became a Sickness." What exactly is Lane's objection to the inclusion of shyness, under the heading of "social phobia" in the DSM? In some instances he objects to the stigmatizing of a normal personality type (78). Ironically, he seems to take such inclusion as implying that there is something wrong, as people, with those who are intensely shy. Perhaps Lane's error is to maintain the old chestnut that a psychological or emotion disorder is in fact a personal defect, a sin of sorts, in a way that a common cold or ALS is not. If this were true then it might make sense to classify and diagnose only those disorders that are unequivocally serious. But, of course, it is not true. The alternative is to look at what the DSM IV categorizes as sometimes horrible and sometimes annoying but in no way a reflection upon personal character. In the latter case one could leave it to the sufferer as to whether he or she will be treated.

My own view is that shyness, as a self-reflective way of experiencing life, contains positive potentials that are most often ignored. But still the common phrase "painfully shy" is not an accident. Shyness is very often painful. The pain is surely not that of clinical depression, but neither does a skin rash feel like a pinched nerve at C-6,7. Lane is working under a top-down model in which the mental health profession determines which patient discomforts deserve its attention. In addition, he does not address the very restricted availability of psychodynamic therapies in comparison to the time and cost of generic Zoloft or the efficacy of the two combined. In resting the profession's manual from the grip of one therapeutic tradition only, perhaps the greatest effect of Spitzer and company's work has been to empower the patient to achieve the care he or she desires and free up the practitioners to provide a wider range of options.

While I do not think Lane makes his case against the DSM IV or against its inclusion of social phobia, I recommend this book as a thought-provoking and informative read.

© 2008 John D. Mullen

John D. Mullen is Professor of Philosophy at Dowling College in Oakdale, New York. He is the author of Hard Thinking: The Reintroduction of Logic into Everyday Life, co-author with Byron M. Roth of Decision Making: Its Logic and Practice, and the author of the widely read Kierkegaard's Philosophy: Self-Deception and Cowardice in the Present Age.

(More recently, see his novel, 'The Philosopher's Lover", 2011, Musa Publishers)
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0 of 3 people found the following review helpful
on January 24, 2013
Format: Paperback
Very much enjoyed the book, but nowhere in it was there an acknowledgment that some people are truly depressed and are truly helped by medication. I agree that our society can make us ill or more ill, and that many people should not be popping anti-depressants, but asking for other kinds of help like therapy, soul-searching, banding together, discipline, etc. And if you are taking anti-depressants, you still have to do these other things. If you have been depressed for years and tried everything but meds, please try meds. On the other hand, it might be that in another society you might not be so sick, but you are not in another society. Do what you have to to survive and then try to fix society.
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3 of 3 people found the following review helpful
on December 10, 2012
Format: Kindle EditionVerified Purchase
A really nice book, a lot of references, well written,, very interesting topic, fun and easy to read. Perfect for mental health workers and for general public.
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2 of 3 people found the following review helpful
on August 14, 2012
Format: Paperback
Lane is such a charming and witty writer that it takes a moment to realize that you have been meticulously led to a very big and very important idea: by giving age old human conditions fancy new titles, quickly embraced by the pharmaceutical industry for cure by drugs, expensive and often ineffective solutions have burdened our society with staggering debt. The read is fun and the impact shocking.
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4 of 4 people found the following review helpful
on January 2, 2012
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This book,should be required reading for every psychologist, psychiatrist, counselor, and social worker in training, and is a must read for those already in practice. While there have been reviews that talk about Dr. Lane's ranting comentary, it is clear that some ranting is appropriate, given the lack professional overview of this important and unfortunate issue, including the danger to the unknowing public. His research is thorough and the text confronts much of the assumption (not limited to shyness) about the field, held by those who would normally bring the information to our attention. I am giving copies to the local psychological association for members to read and then hand to other members. I am appalled that an English professor, rather than a physician or psychologist, was led to write this but, after 36 years in the field, am not surprised.// Thomas McKnight, PhD., ABPP
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5 of 6 people found the following review helpful
on January 25, 2011
Format: Hardcover
Mr Lane joins eminent critics of therapeutic practice and diagnosis who realize indeed that the emperor has no clothes! I read the book through without putting it down! I found it quite compelling! Mr Lane writes plainly and concisely while providing the reader with extensive notes for further reference. His points are well taken at a time when unnecessary medical consumption threatens to bankrupt the country! While serious mental illnesses go untreated in the homeless communities, Mr Lane shows us that the insurance/pharmaceutical/psychiatric complex is expanding mental illness to include up to 50% of the US population by means of absurd and frivolous diagnoses such as shyness ( social anxiety disorder). Kudos to Mr Lane for sounding the alarm to all those who have ever considered therapy or psychotropic drugs. Years from now we'll reflect on this sad time in medical psychiatric practice. Caveat emptor!
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6 of 7 people found the following review helpful
VINE VOICEon March 30, 2010
Format: Paperback
Somewhat by coincidence I was reading this book while also reading the The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. The theme of both books is essentially the same: that modern psychiatry has medicalized otherwise normal conditions. In the Loss of Sadness, the authors argue that normal sadness reactions to life's toils and troubles have been redefined as abnormal via the use of symptoms exclusively, without regard to context or proportionality. Similarly, Christopher Lane argues in his book that shyness and its variants have been stigmatized as conditions requiring pharmaceutical care. Lane focuses on the behind the scenes maneuvering during the process of revising psychiatry's bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM). The main protagonist in Lane's drama is Robert Spitzer, a psychiatrist who pretty much bulldozes his vision of psychiatry into the DSM. That vision is one that places psychoanalysis in the background and brings neuropsychiatry, or the primary use of drugs to deal with conditions, into the foreground. The result is the creation and inclusion of Social Phobia and Social Anxiety into the listing of conditions that require medication.

The role of the pharmaceutical industry is explored, as it takes full advantage of the identification of this new disease and brings its full force of marketing strategies into play. Lane demonstrates with actual ads how Big Pharma marketed their drugs as solutions to life's routine problems, like being shy or nervous at a party. Perhaps the most concerning matter, however, is the push to have younger and younger children prescibed medications to address these supposedly serious conditions and to attempt to nip in the bud more serious developments, with a disconcerting disregard for the not insignificant side-effects of these drugs.

Lane also reaches into films and literature to show how a backlash against the mental numbing of America is forming. Can so many of us really be suffering from so many ailments? What does it mean for us as humans and for our relationships to be constantly drugged to feel better? Lane explores these themes through discussion of novels like The Corrections: A Novel (Recent Picador Highlights)and films like Garden State.

My one complaint with Lane's treatment is that, although he makes a solid presentation on the process that redefined shyness as an illness, there is only a glancing pass at what shyness really is, what its purpose is and how it can be an essential character trait. There is some suggestion for further reading from authorities like Susie Scott, Elisabeth Roudinesco and Jon Elster, but not enough in-depth discussion of shyness itself.

With the upcoming revision of the DSM slated for release in 2011, we may be at a crossroads where the issue of where we want to go for the next decade in mental health is critical. Do we continue on the slippery path of more medications for more "conditions", or do put the brakes on this trend and begin the process of reassessing ourselves and what it means to be humans who have emotions that correspond to life's circumstances.
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